Nonphysicians' and physicians' knowledge and care preferences for Parkinson's disease

Abstract

We compared nonphysician and physician health care providers' knowledge of the pharmacological management of Parkinson's disease (PD) and their preferences for referring PD patients to specialists. A survey instrument was mailed in 2003 to all geriatric, neurology, mental health, and primary care physicians, nurse practitioners, and physician assistants in the Pacific Northwest Veterans Health Administration (n = 503). The instrument contained questions about recommended practices for the pharmacotherapy of PD and two clinical scenarios followed by questions regarding referral preferences. The overall response rate was 74%. Nonphysicians answered 46% and physicians answered 50% of questions about PD pharmacotherapy in agreement with recommended clinical practice (P = 0.14). Nonphysician and physician providers did not differ in their preference to refer a PD patient to a specialist for management, but nonphysician providers were more likely to refer a patient to a specialist for diagnostic confirmation odds ratio: 3.03; 95% confidence interval: 1.67, 5.51). Given trends for more nonphysician provider autonomy in patient care, it is reassuring that nonphysician providers have similar knowledge of PD pharmacotherapy as physicians. Policies to substitute nonphysician providers for physician providers may increase referrals to specialty providers for diagnostic confirmation.

Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

“…Our findings are supported by prior studies showing difficulties in PD diagnosis and delay referral of PD patients to specialists (Swarztrauber K, Graf E., 2007; Gormley GJ, Steele WK, Gilliland A, Leggett P, Wright GD, Bell AL, et al, 2003; Litvan I, MacIntyre A, Goetz CG, Wenning GK, Jellinger K, Verny M, et al, 1998; Hoglinger GU, Rissling I, Metz A, Ries V, Heinermann A, Prinz H, et al, 2004). More than 75% of the participants in this study inaccurately believed that postural instability is an early feature of PD.…”

“…To measure PCPs knowledge of PD, we developed a questionnaire that has acceptable reliability and was applied before and after a CME lecture. We found no between-group differences on general practitioners’ and RNs’ knowledge on PD, as previously reported (Swarztrauber K, Graf E., 2007; Gormley GJ, Steele WK, Gilliland A, Leggett P, Wright GD, Bell AL, et al, 2003; Kaye W, and Mancini ME., 1986). …”

“…Despite the fact that PCPs are frequently the first and at times the only ones to manage PD patients, only a few studies have assessed PCPs’ knowledge gaps on the diagnosis and management of this disorder (Swarztrauber K, and Graf E., 2007; Rybicki BA, Johnson CC, and Gorell JM., 1995; Guttman M, Slaughter PM, Theriault ME, DeBoer DP, and Naylor CD., 2002). To measure PCPs knowledge of PD, we developed a questionnaire that has acceptable reliability and was applied before and after a CME lecture.…”

“…Hence, a considerable knowledge about all these disorders is required to accurately diagnose and appropriately manage patients with PD and related disorders. Studies that compared clinical diagnoses to pathology show that even neurologists specialized in movement disorders may misdiagnose 10–24% of patients with PD; this percentage is likely to be higher if patients are evaluated by primary health care providers (PCPs) (Rajput AH, Rozdilsky B, and Rajput A., 1991; Hughes AJ, Daniel SE, Kilford L, and Lees AJ., 1992; Litvan I, MacIntyre A, Goetz CG, Wenning GK, Jellinger K, Verny M, et al, 1998; Swarztrauber K, and Graf E., 2007). Diagnosis is crucial as there are a variety of pharmacological and non-pharmacological interventions that can improve the quality of life of patients with PD.…”

Awareness and Knowledge of the Clinical Practice Guideline on Parkinson’s Disease among German Neurologists

“…While initial studies are available for general practitioners and internal medicine specialists [20,21,22], our study is the first evaluation of a clinical practice guideline in Neurology in Germany. The focus was on collecting initial experience on the awareness of the guideline on PD and related disorders in everyday medical practice 3 years after its first dissemination.…”